ArticleEuropean heart journal. Case reports2025
Multimodality imaging-guided transcatheter closure of a tortuous LCX-CS fistula: a case report.
Article in European heart journal. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Coronary artery fistula (CAF) is a rare congenital anomaly often detected incidentally. When large, it may cause significant left-to-right shunting, requiring closure in symptomatic cases or those with a substantial shunt volume. While previously treated surgically, transcatheter fistula closure is recognized as an effective and less invasive approach. We report a case of a large, tortuous CAF between the left circumflex artery (LCX) and the coronary sinus (CS) successfully treated with transcatheter coil embolization guided by multimodality imaging. Case summary: A 44-year-old woman presented with exertional dyspnoea and a continuous murmur. Contrast-enhanced computed tomography (CT) revealed a markedly dilated and tortuous CAF arising from the LCX and draining into the CS. Cardiac magnetic resonance imaging (MRI) demonstrated a Qp/Qs ratio of 1.50, and myocardial perfusion scintigraphy showed no ischaemia. Pre-procedural CT revealed a narrowing neck in the distal segment and severe tortuosity of the fistula. Stable access was achieved using a triple coaxial catheter system, which enabled successful coil delivery to the targeted site via an arterial approach. The procedure was completed without complication in a single session. At 6-month follow-up, cardiac MRI showed a reduced Qp/Qs ratio of 1.17, and contrast-enhanced CT confirmed occlusion of the target vessel. Discussion: Transcatheter coil embolization is a safe and effective treatment option, especially for tortuous lesions. In this case, multimodality imaging enabled accurate anatomical and functional assessment and procedural planning. The use of a triple coaxial catheter system contributed to stable access and successful coil delivery in this anatomically challenging lesion.
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